改良式腰硬联合麻醉在瘢痕子宫剖宫产手术的应用

Improved Combined Spinal-epidural Anesthesia in Cesarean Section of Scar Uterus

目的：探讨改良式腰硬联合麻醉应用于瘢痕子宫剖宫产手术的有效性和安全性。方法：选择ASAⅠ-Ⅱ级二次剖宫产术480例，随机分为改良腰硬联合组、传统腰硬联合组两组。改良组硬膜外穿刺成功后，置入腰麻针见脑脊液，根据患者体重蛛网膜下腔注入0．75％罗哌卡因（耐乐品）0．75-1ml，向头侧置人硬膜外导管，立即注射2％盐酸利多卡因5m1，5min没有全脊麻等不良反应后，根据麻醉平面注入0．75％盐酸罗哌卡因7-12ml；传统组硬膜外穿刺成功后，置人腰麻针见脑脊液，根据患者体重蛛网膜下腔注入0．75％罗哌卡因（耐乐品）1．5-2ml，向头侧置人硬膜外导管。记录两组产妇阻滞最高平面固定时间、范围及效果、术中疼痛强度、辅助用药情况、手术医生满意程度、生命体征变化及胎儿娩出后Apgar评分。结果：改良腰硬联合组比传统组最高阻滞平面固定时间更长，各项生命体征更加平稳，升压药使用次数更少，胎儿娩出后Apgar评分更高（P〈0．05）；麻醉阻滞范围、麻醉效果、术中疼痛、辅助用药、手术医生满意度的组间比较，差异无统计学意义。结论：改良式腰硬联合麻醉应用于瘢痕子宫剖宫产术和传统式腰硬联合麻醉效果一样好，但却更安全，更值得临床推广。

Objective： To investigate the validity and security of the improved combined spinal-epidural anesthesia in cesarean section of scar uterus. Method： Four hundred and eighty patients undergoing caesarean section in second time whose ASA between Ⅰ-Ⅱ were randomly and equally divided into improved group and traditional group. After successful epidural-punch, placed spinal anesthesia needle, the patients in improved group were injected 0.75% ropivacaine hydrochloride 0.75-1 ml according to the weight when the cerebrospinal fluid was outflowing, after that, the outlet of punch needle was turned towards head and epidural catheter placed, injected epidurafly 2% lidocaine hydrochloride 5 ml immediately, 0.75% ropivacaine hydrochloride 7-12 ml was injected after 5 minutes＇ observation. Traditional group underwent the same anesthesia steps, but the spinal anesthesia was injected 0.75% ropivacaine hydrochloride 1.5-2 ml by traditional method. The time of the highest level of nerve block fixed, anesthesia effects, pain intensity scores and adjuvant drug treatment was observed and recorded. The changes of vital signs in operation and the Apgar Score of neonates were recorded. Result： The time of the highest level of nerve block fixed in improved group was longer significantly than that in traditional group. The changes of vital signs in improved group were less than those in traditional group. The hypertensive was used less in improved group than in traditional group. Apgar Score of improved group was higher than that of traditional group （ P〈0.05 ） . But the anesthesia effect, pain intensity scores, adjuvant drug treatment, satisfaction of the surgeon were similar between the two groups. Conclusions： The improved combined spinal-epidural anesthesia in cesarean section of scar uterus has the same anesthesia effects, but more safe than the traditional method. It is worth to promote.